The BMA wants ‘locally flexible neighbourhood teams’ to replace PCNs as the vehicle for collaboration between local GP practices.
In a briefing for peers ahead of a debate that took place in the House of Lords earlier this month, the BMA set out the ‘need for reform’ in primary care, including the GP model for at-scale working.
Doctors at the BMA’s annual representative meeting, held in June, had voted in favour of GP practice withdrawal from PCNs by next year, with the doctors’ union instructed to ask for related money to be moved back into core practice funding.
The BMA’s briefing said ‘one size fits all’ PCNs have ‘hampered’ local collaboration and suggested an alternative of more flexible ‘neighbourhood teams’.
It added: ‘We support local collaboration of practices to provide some care at scale, but the PCN DES has hampered this cooperation by applying an inflexible one size fits all model.
‘A move to locally flexible neighbourhood teams to support the care for our patients would be welcomed.’
The NHS England-commissioned Fuller stocktake report published in May that called for PCNs to ‘evolve’ into Integrated Neighbourhood Teams (INTs) by 2024, as well as for urgent same-day appointments to be dealt with by ‘single, urgent care teams’ across larger populations.
But the BMA’s Lords briefing warned that any removal of urgent care from practices would ‘hamper the doctor-patient relationship’ and that continuity of care ‘must be fostered at all costs’.
It said: ‘Urgent on-the-day care is an escalating issue that exerts considerable pressure on practices. [But] whilst we agree that general practice is at and beyond capacity, we do not agree with the removal of urgent on-the-day care from practices.
‘This would hamper the doctor-patient relationship which is often established during a consultation for what seems to be a minor issue. Releasing other workload from general practice into other models would be a more effective way of improving access and reducing workload pressures in practices.’
When the stocktake was published, the BMA said it was ‘refreshing to see Dr Fuller’s honesty about the scale’ of the workforce and workload challenges facing GP practices and the report’s ‘bold suggestions on how to begin to address this’.
However, it added that it ‘will ultimately be determined by the Government’s willingness to act to properly resource practices, while addressing recruitment and retention’.
The BMA briefing also called on the Government to:
- ‘Urgently and properly invest in general practice staff, services and premises and to remove unnecessary targets and bureaucracy’
- ‘Provide consistent public statements of support for GPs and deliver on its commitment to work with the BMA and other healthcare organisations on a national campaign to stop abuse of NHS staff’ amid ‘media scapegoating’ for following Government guidance
- Implement ‘local flexibility of contracting and funding, with a greater emphasis on funding of the core GP contract through simplified means’
- Amend the 2023/24 and 2024/25 PCN contract to include more flexibility in the additional roles reimbursement scheme (ARRS), which would trigger a new opt-out window for the contract
- Invest in increasing the NHS workforce in the long term, accompanied by a workforce strategy and ‘immediate implementation of measures to retain existing staff’
The BMA’s briefing said: ‘General practice is in absolute crisis with overwhelming workload and a rapidly diminishing workforce.
‘Vaccination programmes, the ongoing pandemic and primary and secondary care backlogs are exerting relentless pressure. This is causing burnout and accelerated attrition of available staff hours.’
The BMA’s GP Committee for England is also surveying GPs on whether they would sign up to the PCN DES now, to ‘inform thoughts’.
Meanwhile, the BMA GPC’s latest email bulletin announced that it was launching a new newsletter segment with a ‘question on current issues which will be used to help inform thoughts at GPCE and in negotiations’.
It asked GPs: ‘If given the opportunity today, with the knowledge you now have about the Network DES and how PCNs are working in reality, would you sign up for the Network DES?’
Last month, NHS England said it would work to improve GP access by developing an ‘implementation plan’ for the Fuller stocktake ‘while moving to achieve quick wins in 2022/23’.
And this week, it announced a decision to remove targets while retaining funding for four IIF indicators under the PCN DES, until March next year, in a bid to aid core GP access through winter.
This notably included the indicator incentivising PCNs for offering GP appointments within two weeks of a patient request, despite new health secretary Thérèse Coffey’s patient plan adding this as an ‘expectation’ on practices.
What is happening with PCNs?
The BMA England GP Committee said it would ‘discuss’ how it will ‘enact’ policy to withdraw GP practices from PCNs in July, after GP withdrawal from PCNs by next year became official BMA policy at the highest level.
The 2020 England LMCs’ conference had voted in favour of a similar motion, meaning this should have already represented GPC policy for the last two years, but Pulse understands this was the first time the GPC had actively voted for the policy.
The BMA’s indicative ballot in November last year showed over half of GP practices were willing to opt out of the PCN DES as part of a range of protest measures concerning the Government’s GP access fund.
And while data obtained by Pulse last month revealed more than 99% of GP practices signed up to the 2022/23 Network Contract DES, dashing speculation of a mass PCN exodus, GP leaders stressed this is not emblematic of GP enthusiasm for the DES.